Issue link: https://www.hub.camaf.co.za/i/1541118
12 MEMBER GUIDE - NETWORK CHOICE What is the time limitation for a referral? Referrals are valid for 12 months. What if I visit the same specialist for a new condition? You must obtain a new referral from your nominated GP for other visits to the same specialist for treatment of a new condition. How often do I need to obtain a referral to a gynaecologist when I'm pregnant? You only need to obtain a referral to see a gynaecologist for the first visit. For any subsequent follow-up visits to the same gynaecologist relating to that pregnancy, the claim must simply reflect the initial referral GP name and practice number. What if I decide to change my gynaecologist during my pregnancy? Your claim for your new gynaecologist must have your nominated GP referral. What happens if the specialist prescribes medication? Medication prescribed by a specialist for treatment is subject to the medicines benefit of R4 325. How is this account paid? If you have paid the specialist then scan the account and send to claims@camaf.co.za. Please ensure that your medical aid number appears on the account as well as the referring Network doctor's details. Radiology and Pathology What happens if the specialist refers me for x rays? Basic Radiology referred by a nominated network GP or a specialist is covered at 100% CBT but the costs are subject to the radiology benefit of R5 845 per beneficiary. Limit before PMB/CDL applies. What is the difference between basic and advanced radiology? Basic Radiology - black and white x-rays and soft tissue ultrasound. Advanced Radiology - CT, MRI and PET Scans. The benefit for such radiology is R49 965 per family (in and out of hospital combined and on referral by a nominated network GP or specialist). Limit before PMB/CDL applies. Such claims require authorisation and are paid at 100% CBT. Contact 0860 100 544 for authorisation. You are entitled to have 3 ante-natal scans per pregnancy per annum and these scans are paid at 80% CBT and are subject to the advanced Radiology benefit of R49 965 per family (in and out of hospital combined). Am I covered for a Mammogram? Yes - this is covered under your preventive wellness benefit for all females from 25 years of age. What happens if the specialist refers me for tests e.g., pathology? Basic Pathology tests requested by the specialist are covered at 100% CBT but the costs are subject to the Pathology benefit of R9 320 per beneficiary and the same protocols as those for a GP. Limit before PMB/CDL applies.